Provider Demographics
NPI:1396754537
Name:CLAVIJO, JAIME A (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:CLAVIJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:A
Other - Last Name:CLAVIJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2287
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-2287
Mailing Address - Country:US
Mailing Address - Phone:713-432-9614
Mailing Address - Fax:713-776-1101
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:565
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-432-9614
Practice Address - Fax:713-776-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2191207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152289801Medicaid
TX152289801Medicaid
TXH57401Medicare UPIN